MedAmerica's Transitions

[Bob_The_Insurance_Guy]

With a great number of yuppies getting their kids involved in competitive sports, I might see it as a way to pay for rehab for swimmers (as with my nephew), divers, soccer players.

Not to be sold as LTC, but to be sold as a way to pay for extended physical/sports-related therapy, that regular MM does not cover extensively.

Just thinkin'.

 

[Arthur Rudnick]

With a great number of yuppies getting their kids involved in competitive sports, I might see it as a way to pay for rehab for swimmers (as with my nephew), divers, soccer players.
Not to be sold as LTC, but to be sold as a way to pay for extended physical/sports-related therapy, that regular MM does not cover extensively.

Bob,
Here's my problem...............
I'm assuming that if a kid hurt himself in sports, their parents health insurance policy (major medical) would pay for any hospitalizations, doctor's or other medical expenses. That would also include a few months of PT in order to get that patient back to pre-accident status.

If someone is 65+ and breaks a hip, the hip replacement would be covered by Medicare. Medicare will pay for everything that the kid's major medical would pay for, including PT (either at home or in a re-hab facility), for up to 100 days.

In the above 2 examples, all health insurance policies would pretty much cover 100% of the expenses, other than deductibles & co-pays.

So, back to my original question: "Where does this policy fit in? Who is MedAmerica's target market"?

According to Herman, (who went to MedAmeric'a 4-year "College of Transitions"), it would only be good for Custodial Care.

Let's say that someone (at any age) spent a few days in the hospital with pneumonia. They came home recovered, but weak. Due to that weakness the person needed an aide to help bath, dress, feed, and possibly walk...... That's when Transitions steps in. They will reimburse for as long as the benefit period of 100,200 or 360 days.
To me, that would/should be considered Short Term Care.

If someone is considering a LTC p[olicy, they are not choosing 100, 200 or 360 days of coverage, even if those benefit periods were available (and they're not).

 

[Bob_The_Insurance_Guy]

That would also include a few months of PT in order to get that patient back to pre-accident status.


Nothing could be further from the truth. When my nephew injured his shoulder diving, the health insurance only paid for 24 visits of physical therapy. He needed 127. A little bit short.

 

[Arthur Rudnick]

Nothing could be further from the truth. When my nephew injured his shoulder diving, the health insurance only paid for 24 visits of physical therapy. He needed 127. A little bit short.

OK, in this situation, I stand "partially" corrected..........

Yes, Transitions MIGHT pay for PT on days 25-127. It might pay only in the states that have Transitions filed as Health Insurance. And, keep in mind that this policy also has an elimination period. If it were 60 days, your nephew would have been out-of-pocket for that period. Not sure how many days per week he was receiving PT, but I'd guess that 60 days would knock out a number of those sessions.

It would NOT pay for those PT sessions if Transitions was filed in a state as LTC insurance. If it is a qualified, LTC policy, your nephew would have had to require assistance with 2 activities of daily living for a minimum of 90 days, before you could even have a conversation about benefits being paid.

In spite of the severity of your nephew's accident, did he need help bathing, feeding, dressing, or require assistance in walking or going to the bathroom on a daily basis? Most likely not.

At least that's my take on this policy.

How am I doing on this Herman, do I need to be corrected, or do I have it right?

 

[yankee466]

Since in Georgia, it is a health product.... I am not going to burn brain cells on what does not immediately concern me. I have seen no documentation on their plans where they may be filed as LTC. I'll assume they are different. It implies that maybe the agent selling it will be smart enough not to sell it if he is LTC certified.

But, back to Medicare......day 21-100 will cost you $141.50 day for skilled nursing/rehab...and they will kick you out of rehab as soon as you are not "improving to Medicare guidelines". Not everyone is sitting on a Med Sup Plan F/G/N. Think of all the people on $0 premium MAPD plans who have no coverage after day 20 but a $140/day co-pay. This plan with a 20 day elim would work wonders for some. So, if I was working the lower income crowd, this could be a better than nothing, affordable option for a short term recovery.

By the time you take this plan with 365 day benefit and make it $300/day with 5% simple inflation to build up a big pool, you might as well be looking at MedAmerica Flexcare with a one year benefit as a comparison.

And also on MM, the other post was right on....they all limit coverage on home health, therapies, etc....so you get kicked to the curb pretty quickly, and very few people realize that. "Unlimited benefit" MM plans do not mean everything is unlimited.

There are lots of opportunities to use this and plans from GTL and Standard Life as supplemental plans to plug holes in other products at a relatively low cost...so I can see a need for the product. Its just that there would be no reason to pull out the product for someone who comes to you needing LTC.

Maybe we should move the thread to the Medicare board and see what happens?

 

[Arthur Rudnick]

Maybe we should move the thread to the Medicare board and see what happens?

Correct me if I'm wrong, but you seem to feel that this product fits in for those on Medicare. MedAmerica, in their marketing guides, talk about someone in a mortorcyle accident also taking advantage of a Transitions policy. So, they're marketing to the 30+ crowd.

Let's leave it at this.................

For the agent out there who sells a Transitions policy, please get back to this thread and let us know who you sold a policy to and why did both you & the applicant feel it was an appropriate policy?

I'm with a GA with thousands of agents/brokers and to date, not one Transitions policy has been sold.

 

[Bob_The_Insurance_Guy]

In spite of the severity of your nephew's accident, did he need help bathing, feeding, dressing, or require assistance in walking or going to the bathroom on a daily basis?

Bathing, yes. Feeding, no. Dressing, yes.

I'm not saying it's a widespread answer, but I do submit it is a viable product.

 

[yankee466]

The brochure for the product gives some "real life examples"

http://brunsinsuranceservices.com/Transitions_Client_Brochure.pdf

The examples listed support much of our earlier chats. I'll certainly let everyone know if I come across someone who has sold this.